Periodontal Therapy Treatment Plan Question And Answers

Treatment Plan

Question 1. Write short note on maintenance care.
Answer. Mostly chronic infections require supervision and maintenance overtime.

• Maintenance phase after active treatment includes not only the care that patients receive thorough personal oral hygiene but also by the recall visits, and re-evaluations done by dental team.
• It is also supportive in nature hence also known as supportive phase periodontal.

Rationale for Maintenance Phase

To prevent or minimize the recurrence of periodontal diseases by controlling factors known to contribute to disease process.

Objectives of Maintenance Phase

• Preservation of alveolar bone support.
• Maintenance of stable, clinical attachment level.
• Reinforcement and re-evaluation of proper home care.
• Maintenance of a healthy and functional oral environment.

Read And Learn More: Periodontics Question And Answers

Maintenance Phase

• Periodic recall visit.
• Checking for plaque and calculus.
• Gingival condition (Pockets, inflammation).
• Occlusion, tooth mobility and other pathologic changes.

Determination of Maintenance Recall Intervals

Patients require recall for inspection, oral hygiene monitoring and scaling at 3 month, 6 month, 9 month or 12 month intervals depending on previous disease experience and susceptibility.

Following factors may be considered in determining the recall intervals:

• Severity of disease: The more severe the disease, the more frequently the patient is recalled.
• Effectiveness of home care: Good home care decreases the frequency of recall.
• Degree of control of inflammation achieved: As the tissue regain the total health. The frequency decreases.

Question 2. Write short note on etiotropic phase of periodontal therapy.
Answer. It is known as etiotropic phase because its goal is to eliminate the etiologic factor of periodontal diseases.

It is also known as initial phase, nonsurgical phase and hygienic phase.

Objectives of Etiotropic Phase Therapy

• To reduce or eliminate the gingival inflammation.
• To eliminate the periodontal pocket produced by the edematous enlargement of inflamed gingiva.
• To achieve surgical manageability of gingiva.
• To improve healing after periodontal surgery.

Primary goal of etiotropic phase is the elimination of inflammation and plaque control, which includes following:

• Patient education and motivation
• Mechanical plaque control: Scaling and root planning.
• Correction of restorative and prosthetic irrational factors: Overhanging margins of dental restoration should be removed.
• Excavation of caries and restorations (temporary or final): Caries control should be performed. Amalgam and composite restorations can be performed to close contacts and to correct food impaction.
• Topical and systemic antimicrobial therapy: Chemical control of plaque can be achieved by mouthrinses, irrigation and antibiotics.
• Occlusal therapy: Occlusal adjustment should follow scaling and root planning. If tooth is mobile gross occlusal adjustment should be done before scaling to reduce mobility.
• Minor orthodontic movement: It can precede or follow any surgical interventions. It is performed as a part of phase I but when there are inflammation or bone deformities due to tooth alignment. Major orthodontic tooth movement done for purposes of reconstruction or esthetics may follow surgery.
• Provisional splinting and prosthesis: Wire ligation and composite acid etched splintings are performed during phase 1 therapy. Temporary splinting can be done to control secondary occlusal trauma before the surgical planning.
• Diet control: Diet control or diet modification is done.
• Additional preventive measures: These include fluorides which are advised to caries prone patient.

Reevaluation Visit

• It is performed in 4 to 8 weeks following completion of initial phase of periodontal therapy.
• All the data taken during the initial visit should be recollected at re-evaluation visit such as oral hygiene status, gingival inflammation, bleeding on probing, probing depth, attachment level, dental caries and calculus.

Question 3. Write short note on the treatment plan.
Answer. Treatment plan is the sequential outline of the essential services and procedures that must be carried out to eliminate the disease and to restore the oral cavity to health and normal function.

• It is the blueprint for the case management and establishment of the periodontal health.
• Treatment procedures should be performed in the systemic sequence and should be planned well in advance.

Rationale for the Treatment Plan

• To eliminate pain, gingival inflammation and gingival bleeding.
• To reduce periodontal pocket formation and elimination of infection.
• To arrest purulent exudates and destruction of soft tissue as well as bone.
• To reduce abnormal tooth mobility.
• To establish optimal occlusal function.
• To restore the tissue destroyed by the disease and reestablish physiological gingival contour
• To prevent recurrence of the disease
• To reduce the tooth loss

Phases of Treatment Plan

• Preliminary phase or emergency phase
• Phase 1: Etiotropic phase
• Phase 2: Surgical phase
• Phase 3: Restorative phase
• Phase 4: Maintenance phase

Preliminary Phase

When patient has pain, swelling and infection the emergency condition is resolved before phase 1 therapy.

These emergencies take priority over other treatment scheduling:

• Alleviate pain: Pain should be controlled first.
• Swelling: If pain is absent and swelling is present it needs immediate attention.
• Acute lesions of periodontium such as abscess, necrotizing periodontal diseases require emergency care due to associated pain. Endodontics may be necessary as an emergency measure when there is pulpitis, apical abscess or combined periapical-periodontal abscess.
• In traumatic lesions
• Extraction of hopeless teeth: Extreme mobile teeth interfere with function and should be extracted.
• Repairing of defective prosthesis.

Phase 1: Etiotropic Phase

It is known as etiotropic phase and its goal is to eliminate the etiologic factor of periodontal diseases.

It is also known as initial phase, non-surgical phase and hygienic phase.

Primary goal of etiotropic phase is the elimination of inflammation and plaque control which includes following:

• Patient education and motivation
• Mechanical plaque control: Scaling and root planning.
• Correction of restorative and prosthetic irritational factors: Over hanging margins of dental restoration should be removed.
• Excavation of caries and restorations (temporary or final): Caries control should be performed. Amalgam and composite restorations can be performed to close contacts and to correct food impaction.
• Topical and systemic antimicrobial therapy: Chemical control of plaque can be achieved by mouth rinses, irrigation and antibiotics.
• Occlusal therapy: Occlusal adjustment should follow scaling and root planning. If tooth is mobile gross occlusal adjustment should be done before scaling to reduce mobility.
• Minor orthodontic movement: It can precede or follow any surgical interventions. It is performed as a part of phase I but when there are inflammation or bone deformities due to tooth alignment. Major orthodontic tooth movement done for purposes of reconstruction or esthetics may follow surgery.
• Provisional splinting and prosthesis: Wire ligation and composite acid etched splintings are performed during phase 1 therapy. Temporary splinting can be done to control secondary occlusal trauma before the surgical planning.
• Diet control: Diet control or diet modification is done.
• Additional preventive measures: These include fluorides which are advised to caries prone patient.

Reevaluation Visit

• It is performed in 4 to 8 weeks following completion of initial phase of periodontal therapy.
• All the data taken during the initial visit should be recollected at reevaluation visit such as oral hygiene status, gingival inflammation, bleeding on probing, probing depth, attachment level, dental caries and calculus.

Phase 2: Surgical Phase

Periodontal surgical procedures includes:

• Pocket reduction/elimination procedures:
  • Gingivectomy
  • Periodontal flap surgery
  • Regenerative procedures
• Periodontal plastic surgery techniques:
  • Root coverage procedures
  • To widen width of attached gingiva
• Preprosthetic surgical procedures:
  • Crown lengthening with or without osseous recontouring
  • Ridge augmentation
• Osseous surgeries: Resective and regenerative surgeries
• Implant surgery:
  • Guided bone regeneration
  • Placement of implants
  • Sinus lift procedures

Phase 3: Restorative Phase

It consists of:

• Final restorations
• Fixed and removable prosthesis
• Evaluation of response to restorative procedures
• Periodontal examination

Until all active periodontal therapy is completed, final restorative care should be delayed, as tissue contours may be altered during subsequent periodontal treatment.

Phase 4: Maintenance Phase

It is the very essential part of periodontal treatment plan.

Following procedures should be carried out at various visits.

• Periodic recall visit.
• Checking for plaque and calculus.
• Gingival condition (Pockets, inflammation).
• Occlusion, tooth mobility and other pathologic changes.

Determination of maintenance recalls intervals is necessary. Patients require recall for inspection, oral hygiene monitoring and scaling at 3 month, 6 month, 9 month or 12 month intervals depending on previous disease experience and susceptibility.

As the phases of treatment plan are given sequentially but the recommended sequence should not follow the numbers, e.g. After completion of Phase I therapy, patient can be placed directly on Phase IV therapy to prevent any further deterioration and recurrence of disease.

Question 4. Write short note on phase periodontal therapy.
Or
Write short note on phase 1 therapy.
Answer. Phase 1 periodontal therapy is also known as nonsurgical periodontal therapy, initial therapy, cause related therapy and etiotropic phase of therapy.

• It is the first step in chronologic sequence of procedures which constitute periodontal treatment.
• Objective of Phase 1 therapy is to alter or eliminate the microbial etiology and contributing factors for gingival and periodontal diseases.
• Following are the therapies which are needed to control or eliminate the local contributing factors:
  • Complete removal of calculus
  • Correction or replacement of poorly fitting restorations and prosthetic devices
  • Restoration of carious lesions
  • Orthodontic tooth movement
  • Treatment of food impaction areas
  • Treatment of occlusal trauma
  • Extraction of hopeless teeth.
• Following conditions must also be considered to plan the phase 1 treatment sessions needed:
  • General health and tolerance of treatment
  • Number of teeth present
  • Amount of subgingival calculus
  • Probing pocket depths and attachment loss
  • Furcation involvements
  • Alignment of teeth
  • Margins of restorations
  • Developmental anomalies
  • Physical barriers to access (i.e. limited opening or tendency to gag)
  • Patient cooperation and sensitivity.

Dentist should estimate the number of appointments needed on the basis of the conditions presented by each patient. Consideration should be given to the control of infectious organisms during period of active Phase I treatment.

Sequence of Procedures in Phase 1 Therapy

Step 1: Limited plaque control instruction

• This step should start in the first treatment appointment and should include only the correct use of the toothbrush on all smooth and regular surfaces of the teeth.
• The use of dental floss should follow the removal of calculus and the overhanging restorations.

Step 2: Supragingival removal of calculus

This step should be carried out with scalers, curettes or ultrasonic instrumentation.

Step 3: Recontouring defective restorations and crowns

• This step may require replacing the complete restoration or crown or correcting it with finishing burs as well as diamond coated files mounted on a special handpiece.
• For overhangs which are located subgingivally, it may be require to reflect a miniflap to facilitate access.

Step 4: Obturation of carious lesions

• This involves complete removal of the carious tissue and placement of a final or a temporary restoration.
• Caries control as well as treatment of active carious lesions are often overlooked aspects of phase I therapy.
• Caries is now recognized as infection. Frank carious lesions, particularly class V lesions in the cervical areas of teeth and those on root surfaces, provide a reservoir for bacteria and can contribute to the repopulation of the periodontal plaque.
• Cavities are the receptacles where plaque is sheltered from even the most energetic mechanical plaque removal attempts.
• For these reasons, it is imperative that caries control and at least temporization of carious lesions be completed during phase 1 therapy.

Step 5: Comprehensive plaque control instruction

At this step, the patient should learn to remove plaque completely from all supragingival areas, using toothbrush, dental floss and any other necessary complementary method.

Step 6: Subgingival root treatment

At this step, complete calculus removal and root planning can be effectively performed and constitute the final step in achieving smooth and regular contours on all tooth surfaces.

Step 7: Tissue re-evaluation

• Periodontal tissues are reexamined to determine the need for further therapy. Pockets are resorbed, and all related anatomical conditions are carefully evaluated to decide whether surgical treatment is indicated.
• Additional improvement through surgery can be expected, only if phase I therapy has been successful.
• Surgical treatment of periodontal pockets should be attempted only when the patient is doing effective plaque control and the gingiva is free from overt inflammation.

Results of Phase 1 Periodontal Therapy

Periodontal cases should be reevaluated 4 weeks after completion of scaling and root planning. This permits time for both epithelial and connective tissue healing and allow the patient sufficient practice with oral hygiene skills to achieve maximum improvement.